Historically, physician credentialing has been seen as one-dimensional. It’s been considered an administrative necessity for patient safety and compliance—not a strategic path ahead for health plans and care delivery organizations. This is shifting—today, innovative healthcare organizations understand that faster medical credentialing is a real lever for growth.
In other words, optimized provider credentialing has the power to drive operational efficiency, grow provider networks, and fast-track broader strategic goals.
Verifiable customer, Humana Dental, has been seeing wide-scale improvements as a result of implementing our technology in their organization. So, it’s no surprise that this Q&A between Rehan Mirza, Chief Growth Officer at Verifiable, and Dara McDaniel, Associate Director of Credentialing at Humana is an enthusiastic one. Moderated by Becker’s Healthcare, Brian Zimmerman, this conversation can be found in complete audio format on Becker's Payer Issues Healthcare Podcast.
Read along (or listen in) as we discuss Humana Dental’s transition to in-house credentialing; share real-life benefits of insourcing credentialing; and discuss how fast-tracked credentialing impacts network expansion, patient access to care, and even revenue.
Q: From your point of view, can you describe how credentialing affects the broader operational landscape?
Rehan Mirza (Verifiable): Credentialing directly affects operations. If you have clinicians sitting on the sidelines, then you also have patient schedules piling up on the payer side.
It's a hidden bottleneck. Slow credentialing has massive implications on your operational performance. It impacts the revenue cycle and overall provider satisfaction and experience.
When we talk to organizations, their credentialing challenges typically tie into larger challenges from revenue, provider experience, or operational efficiency perspectives. When organizations credential better, they see a lift that impacts all departments.
Dara McDaniel (Humana): Myself and my team are the first impressions for our providers. I've seen health plans where it takes six to eight months to credential a provider and that's not acceptable.
At Humana, we wanted to come up with the most efficient, streamlined way to credential. We want to get providers onboarded and have them start seeing members as fast as possible. This goal helps all the downstream departments and the whole wheel of Humana.
Q: What has that impact been on improving credentialing speed and experience for providers?
Dara McDaniel (Humana): I came to Humana a little less than three years ago. When I got here, we were using a third-party CVO to do our credentialing. I had a team of about 18 people that came in and basically, their role was to gather documents. They were credentialing specialists, but they would gather the documents, reach out to the provider, and then send them to the CVO.
And then looking at my past, I was like, “I know that there are capabilities out there and we can automate this”. And so I started thinking, “Okay, what would the steps be to bring this in-house?”.
One of the things that I was passionate about was not creating another system for the team to log into. I wanted to look at our current platform and see if there were capabilities we could build, and then add on an API [Verifiable]. And so we started building early last year.
Since then, the credentialing turnaround times have been crazy. We knocked out the middleman and have automated monthly monitoring. Before, we were taking Excel spreadsheets (about six of them), putting them together and merging them to find providers that had the sanction hits. Now, we're able to automate that and it alerts us.
With ongoing network monitoring, we have our verifications continually running in the background. It's been a huge cost savings. We were able to term our contract with our vendor last summer.
And there's also been a sense of accomplishment within my team. I've noticed a sense of employee satisfaction because now they're fully credentialing specialists. They're able to credential the provider from the whole end-to-end process. We’ve given them a little bit more empowerment to do their jobs.
These systems are just so amazing. You can really streamline the process a lot.
Q: How have accelerated or fast-track credentialing processes affected payers?
Rehan Mirza (Verifiable): Because of the former lack of automation, many payer organizations have just seen credentialing as a compliance “box check”. They haven't thought of it as a strategic, competitive advantage. And if it’s only seen as an administrative headache, it makes sense to outsource it.
Today, organizations and payers are starting to think about their operational excellence in this new normal we’ve talked about. It’s more important than ever to think about provider experience and the accuracy, freshness, and validity of clinician data.
As a result, more and more organizations are asking, “What does it mean to own more of the credentialing process?”.
Now, you can automate physician credentialing, bring it in-house and really have that control. You can centralize provider data on systems like Salesforce and use a solution like Verifiable to create an end-to-end chassis of your provider data strategy. Organizations are starting to experience faster turnaround times, greater visibility, and the ability to react to the provider’s needs. And it’s in service of delivering great care to your members while staying compliant.
Instead of the provider credentialing process happening off-platform, siloed in some digital filing cabinets, if these activities are centralized, there becomes a foundation for provider data that can be used for a larger strategy.
We're at a really interesting nexus where there’s been a mindset shift. And the more conversations we have, the more excited we get. More and more health plans are seeing that there's an opportunity to put their hands on the reins and drive themselves to success.
Q: Anything you’d like to emphasize about Humana’s approach or insourcing credentialing?
Dara McDaniel (Humana): I would love to challenge people who are in the credentialing space to do the research and to look to see what’s out there. If you're doing things in a manual way, there are easier, faster processes that are truly mind-blowing.
I want everyone to take a look at their options so that they can streamline and have a better provider experience.
Q: Any closing thoughts on credentialing in-house through automation?
Rehan Mirza (Verifiable): Organizations shouldn’t think of credentialing as just a compliance thing that they need to do. Instead, it should be viewed from a business strategy or key outcomes perspective.
We should be asking, “Can physician credentialing be a contributor to revenue acceleration? Can credentialing be a key contributor and driver of cost savings with automation? And can it lead to provider accuracy and provider experience?”.
At Verifiable, our goal is to be a tributary to help create centralized systems of truth. Being API-first, we have many customers who are plugging our data verification and pipelines into core systems, like Salesforce. This starts to create an accurate picture of the provider network that can drive network operations. It can start as a small piece, but it snowballs and can have a huge impact on your org.
It’s really energizing when customers realize that insourcing credentialing drives impact across their businesses.
Listen to the full discussion between Rehan Mirza, Chief Growth Officer at Verifiable, and Dara McDaniel, Associate Director of Credentialing at Humana on Becker's Payer Issues Healthcare Podcast.
